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Difficulty: HardAssignment, Delegation and Supervision

On a progressive neurology unit, a registered nurse (RN) coordinates care with a licensed practical/vocational nurse (LPN/VN) and an unlicensed assistive personnel (UAP). Upon reviewing the ongoing unit activities, which observed actions indicate that delegation has been implemented safely and correctly? Select all that apply.

  1. A
    The UAP assists a client who suffered an acute stroke and developed new-onset dysphagia with their first oral feeding.
  2. The LPN/VN administers scheduled oral antiepileptic medications to a stable client with a documented history of seizures.Answer
  3. C
    The LPN/VN performs a focused neurological assessment on a client reporting a sudden, severe, and 'worst-ever' headache.
  4. The UAP empties an indwelling urinary catheter bag and documents the hourly output for a client receiving a continuous diuretic infusion.Answer
  5. The LPN/VN performs routine sterile tracheal suctioning for a client with a well-established tracheostomy.Answer
  6. F
    The UAP reviews printed discharge instructions regarding fall precautions with a client recovering from a lumbar laminectomy.

Answer

The safe and correct delegations include the LPN/VN administering routine oral medications, the UAP measuring and documenting urinary output, and the LPN/VN performing sterile suctioning on an established tracheostomy.
Safe delegation mandates that tasks are assigned based on the legal scope of practice and the client's current level of clinical stability. Administering scheduled oral medications to a stable client and performing sterile suctioning on a well-established tracheostomy are within the LPN/VN scope of practice. Measuring, emptying, and documenting fluid output is a standard, routine task suitable for a UAP because it requires no nursing judgment.

Step-by-Step Solution

1
Evaluate the UAP feeding the client with new-onset dysphagia.
Inappropriate delegation.
New-onset dysphagia presents a high aspiration risk, necessitating the RN's clinical judgment and assessment during the initial feeding.
2
Evaluate the LPN/VN administering oral antiepileptics.
Appropriate delegation.
The client has a stable, documented history of seizures, making routine oral medication administration appropriate for the LPN/VN.
3
Evaluate the LPN/VN assessing the severe headache.
Inappropriate delegation.
A 'worst-ever' headache indicates an acute, unstable condition requiring immediate advanced clinical judgment and assessment by the RN.
4
Evaluate the UAP documenting hourly urine output.
Appropriate delegation.
Emptying a catheter and recording the output are basic, non-invasive tasks within the UAP scope, regardless of the client's continuous IV therapy.
5
Evaluate the LPN/VN performing sterile suctioning.
Appropriate delegation.
LPN/VNs are trained to perform sterile procedures on established, stable respiratory airways.
6
Evaluate the UAP reviewing discharge instructions.
Inappropriate delegation.
Teaching and providing health education to a client, even using pre-printed materials, is entirely an RN responsibility.

Key Concept

Scope of practice and safe delegation principles based on client stability, potential for harm, and task complexity.
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Topics

Assignment, Delegation and Supervision

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